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From YouTube: Budget Review Subcommittee on Human Resources (9-24-21)
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A
Good
morning
welcome
to
meeting
four
budget
review
subcommittee
on
human
resources.
We
appreciate
everyone's
indulgence
as
we
work
to
reschedule
our
previous
meeting
held
on
september
8th
because
of
the
call
of
our
special
session
and
as
a
reminder,
remote
access
is
allowed
to
all
meetings
for
2021
interim
session
members
are
provided
a
zoom
link
to
access
the
meeting
remotely
the
main
materials
were
put
online
earlier
this
week
and
made
available
for
downloading
at
this
time.
We'll
have
the
secretary
call
the
roll.
B
A
Thanks
everyone:
next,
we
have
approval
of
the
minutes
from
the
august
4th
meeting.
Is
there
a
motion
motion
motion
by
co-chair
bentley
seconded
by
senator
carroll?
Also
for
the
emotion
say,
aye
any
opposition
right
minutes
are
approved
before
we
begin
presentations
for
members
participating
remotely.
A
Please
remember
to
meet
your
microphones
and
if
you
have
questions,
certainly
we'll
acknowledge
that
when
it
comes
time
for
questions,
but
this
morning
we're
going
to
have
a
presentation
from
commissioner
lee
and
steve
bechtel
chief
financial
officer
with
department
of
medicaid
services,
they'll
provide
us
with
fiscal
year,
2021
close
out
numbers
outlook
for
fiscal
year,
2022
for
the
medicaid
budget.
So,
commissioner,
if
you're
on
board
and
steve
as
well,
please
identify
yourself
for
the
record.
A
D
D
Next
slide,
please,
we
have
a
little
bit
of
our
eligibility
experience
here.
You
can
see
that
traditionally,
we've
had
some
churn
in
the
in
the
program
overall,
but
in
april
of
2020
you
can
see
that
cove
had
definitely
had
an
impact
on
the
number
of
individuals
requiring
services.
Through
the
medicaid
program,
we
have
seen
a
little
bit
of
a
slight
drop
off
in
july
of
2021.
D
D
E
Thank
you,
commissioner.
Can
everyone
hear
me
okay?
Yes,
thank
you.
Okay,
I've
got
this
headphones
on.
I
just
wanted
to
make
sure
that
that
you
can
hear
me
clearly
and
but
I
went
back
to
to
to
the
eligibility
graph
there
that
the
commissioner
was
just
talking
about.
I
just
want
to
point
out.
I
mentioned
this
in
another
committee
setting
in
the
medicaid
oversight
committee,
but
I
know
some
of
you
are
not
on
that
committee.
So
I
just
wanted
to
point
out.
E
One
thing
is
when,
when
we
got
the
6.2
percent
increase
fmap
by
cms,
when
they
they
gave
that
to
us,
they
had
an
expectation,
they
had
a
condition
called
maintenance
of
effort,
and
what
that
means
is
that
we
had
to
provide
continuous
coverage
for
individuals.
We
could
not
disenroll
anyone
and
that's
why
you
see
prior
to
the
pandemic
period.
E
You
see
that
churn
up
and
down
up
and
down,
but
then
you
have
a
steady
line
straight
up
starting
in
april
all
the
way
up
through
I
guess,
sometime
october,
but
but
the
only
there
was
only
three
reasons
or
three
three
cases
or
situations.
I
should
say
that
cms
would
allow
us
to
drop
someone
from
the
rose
and-
and
that
was
due
to
the
death
of
the
individual
or
the
individual
moving
out
of
the
state
or
that
the
individual
actually
requested
to
be
disenrolled
from
the
program.
E
So
so
that's
why
you
see
that
pretty
much
steep,
steep
kind
of
slope
there
straight
up
straight
increase
with
no
churn,
then
in
late
in
2020,
cms
came
back
out
with
some
updated
guidance
and
that
updated
guidance
said
that
they
did
not
intend
to
include
the
presumptive
eligibility
or
the
temporary
eligibility
programs
in
that
maintenance
of
effort.
So
that's
when
we
started
dropping
off
some
of
the
pe
members
you'll
see
because
they
get
they'd
get
two
pe.
E
But
now
we
do
have
a
little
bit
of
churn
and
you
can
see,
like
commissioner
said
on
on
july
1st,
we
had
some
pe
members
drop
out
about
120
000
presumptive
eligibility
members
dropped
off
on
july,
1st
they
exhausted
their
their
two
calendar
year
segments
and
but
you
can
still
see,
there's
a
slight
increase
continuing
since
then.
So
I
just
wanted
to
point
that
out,
because
you
know
eligibility
is
one
of
the
main
things
that
drives
our
budget
along
with
with
reimbursements.
E
E
So
when
you
combine
those
two
factors,
obviously
eligibility
is
going
to
increase
and
stay
at
it
at
high
levels.
So
I
just
wanted
to
point
that
out
real
quick
before
we
get
going
into
the
actual
numbers,
I'm
a
numbers
guy
so
you'll
have
to
I
may,
as
senator
meredith
has
said
in
the
past,
I
throw
it
as
a
fire
hydrant
at
you.
You
may
I'll
be
glad
to
take
any
questions
you
may
have
after
the
presentation.
E
This
first
slide
I
just
updated
from
what
we've
provided
in
the
past.
What
I've
provided
you
here
is
the
actual
expenditures
from
2018
through
2019,
and
I
broke
it
out
by
general
fund,
restricted
funds
and
our
federal
funds,
but
then
also
you
can
see
the
total,
so
you
can
see
that
in
21
we
had
when
compared
to
20.
Those
are
the
two
two
areas
I
want
to
concentrate
on
on.
This
slide
is
looking
at
21
compared
to
20..
E
When
you
look
at
the
federal
funds
9.4
compared
to
the
11.7
that
we
spent
in
21,
that's
a
2.3
billion,
that's
91.4
percent
of
the
overall
increase
that
that
we've
seen
that
is,
you
know.
I
know.
That's
still
tax
dollars,
but
those
are
federal
tax
dollars
that
we're
able
to
bring
into
the
state
and
make
sure
that
our
state
is
receiving
funding.
And
you
know
I
don't
ever
like
to
call
ourselves
an
economic
engine
by
any
means,
because
that's
not
our
goal,
it's
not
our
mission,
but
a
lot
of
times.
E
The
other
thing
that
I'll
show
you
here
is
the
185
million
dollar
increase,
roughly
185
million
increase
on
the
restricted
funds.
When
you
look
at
20
it
was
478
and
21
to
662..
That's
that's
about
a
38
increase.
That
is
mainly
due
to
the
a
trip
program
on
the
house,
the
hospital
rate
improvement
program.
E
I
believe
it's
house
bill
183
and
that
that's
due
to
the
assessment
piece
that
the
hospitals
pay.
They
cover
a
lot
of
the
state.
They
cover
the
state
portion
of
that
payment,
it's
over
a
billion
dollars
that
we
pay
them,
but
they
also
paid
the
the
assessment
to
cover
the
state,
and
so
that
does
not.
We
use
those
funds
as
restricted
funds
so
that
we
can
restrict
it
to
that
program
and
then,
in
general
funds
itself,
we
had
about
a
30
million
35
million
dollar
increase,
which
is
very
slight.
E
E
E
E
E
I
I've
been
doing
this
for
a
while.
I've
met
with
several
of
you
before,
and
you
know.
One
thing
that
I
make
sure
is
that
we're
being
good
stewards
of
the
taxpayer
dollars
and
that
we're
trying
and
commissioner
will
tell
you
that
whenever
we're
talking
about
a
new
program,
my
first
thing
out
of
my
mouth
is
well:
do
we
have
the
ability
to
sustain
this?
Do
we
have
the
budget
to
sustain
this?
E
Will
we
have
the
funding
to
sustain
this,
that
those
are
the
things
that
come
out
of
my
mouth,
with
every
conversation
that
I
have
on
programs?
So
I
don't
want
you
thinking
we're
just
spending
this
willingly
like
just
flying
it
out,
but
I
just
wanted
you
to
know
that
there
are
good
good
decision
making
good
thought
process
that
is
going
through
every
decision
that
we
make
in
the
tor
in
the
department.
E
This
next
graph
will
show
you,
I
call
it
my
pacman
graph,
so
to
speak.
You
can
see
that
75
of
our
total
budget,
the
14.4
billion
it
was
spent
with
managed
care.
Now
I
want
to
caution
you
on
that,
because
some
of
these
funds,
a
lot
of
these
funds,
are
maybe
I
should
say,
paid
to
or
through
the
managed
care
organizations,
because
we
have
some
supplemental
payments,
such
as
the
a
trip
program
such
as
university
directed
payments
such
as
house
bill,
8,
the
the
ambulance
provider
payout.
E
E
They
only
allow
us
to
carve
out
one
supplemental
payment
and
the
only
supplemental
payment
to
allow
that
to
happen
is
the
gme,
which
is
the
gradual
medical
graduate
medical
expenditures
that
we
and
we
did
carve
that
out.
We've
carved
that
out
on
july
1st
of
2020,
and
we
are
paying
that
strictly
through
an
enhanced,
actually
an
enhanced
program
that
we
got
approved
through
cms
to
pay
that
out
solely
through
the
fee
for
service
arena.
E
The
other
25
of
the
funds
24.8
was
spent
in
our
fee
for
service
arena,
and
we've
highlighted
some
of
the
key
areas
here:
nursing
facilities
and
alternative
community
care,
which
are
also
known
as
the
waivers
programs.
You
can
see
those
two
are
the
highest
paid
amounts
in
our
fee
for
service
arena,
and
then
we
have
also
included
transportation
dental.
I
know
dental
is
a
hot
topic
right
now,
so
I
wanted
to
provide
you
that
information,
pharmacy,
icf,
idd
and
hospitals.
E
E
D
So
steve
before
you
move
on
I'd
like
to
to
point
out
on
that
slide.
The
dental
and
the
pharmacy
costs
that
you
see
over
on
the
right
side
of
your
screen
are
those
costs
provided
by
fee
for
service.
Only
those
those
facilities,
those
provider
types
did
receive
other
funds
through
the
managed
care.
I
just
wanted
to
make
sure
that
you
understand:
that's
not
the
total
that
those
providers
received
it's
just
those
four
individuals
enrolled
in
our
long-term
care
communities
and
our
waiver
programs.
So
that's
not
their
total
expenditures.
E
E
This
slide
here
we're
going
to
go
in
depth
about
the
2.5
billion
real,
quick,
the
2.5
billion
increase.
Why
did
we
see
that
increase
from
in
21
and
we'll
go
more
in
depth
on
the
managed
caroline
here
in
a
second?
But
in
emt?
You
can
see
that
our
non-emergency
medical
transportation,
that
we
contract
with
the
transportation
cabinet
to
the
process
and
to
manage
you
can
see
that
we
had
a
39
million
dollar
increase
over
20.
When
you
compare
21
to
20.
E
and
that's
about
a
38
increase,
we
we
pay
them
a
per
member
per
month
as
well
to
each
one
of
those
brokers
in
those
regions
to
provide
the
that
that
care
and
provide
that
that
delivery
service
to
to
to
the
members
that
we
serve,
and
so
basically
this
is.
This
increase
is
solely
solely
tied
to
the
increase
in
enrollment
that
we've
had
over
the
last
year
compared
to
20..
E
So
so
you
can
see
that
it's,
it's
a
large
increase,
it's
37.8
percent
increase,
but
that's
that's
told,
sadly,
to
that's
tied
solely
to
the
enrollment
increase.
I
mentioned
drug
rebate.
Just
a
second
ago.
You
can
see
that
drug
rebate.
We
had
about
168
million
dollars
more
in
drug
rebate
in
21
than
we
had
in
20..
This
is
this
is
kind
of
a
you
can
see
a
trend.
E
So
I
anticipate
if
we
are
still
following
that
trend,
that
in
22
that
we
will
not
have
we'll
have
less
of
drug
rebates
than
what
we
had
in
this
year.
I
hope
I'm
wrong
because
that
that
helps
us
offset
a
lot
of
our
expenditures,
but
but
that's
what
we're
we'll
we'll
be
monitoring
that
pretty
closely?
The
other
thing
is
the
fee
for
service
line.
You
can
see
it's
a
1.8
percent
increase
it's
75
million,
some
of
that
is
tied
to
the
29
add-on
that
was
placed
in
house
bill
192.
E
for
our
nursing
facilities
that
we're
managing
that
we've
that
we've
implemented
and
got
approved.
So
some
of
that
is,
is
that
increase.
But
let's
talk
more
about
the
managed
care
lines,
the
managed
care
line
is:
is
2.5
billion,
it's
pretty
much
the
entire
amount,
but
I
wanted
to
point
out,
like
I
told
you
earlier,
there's
there
are
some
supplemental
payments,
but
first
of
all,
there's
about
51.
E
51.5
of
that
increase
is
due
to
increase
enrollment.
We've
already
talked
about
how
our
enrollment
has
has
increased
greatly
we're
paying
a
per
member
per
month,
so
each
each
for
each
month
that
those
members
are
the
eligibility
side
were
having
to
pay
that
per
member
per
month,
cost
regardless
if
they
get
a
utilization
or
not.
E
Now
I
will
tell
you
there
is
a
90,
mlr,
still
still
effective
and
still
still
assigned
to
this,
but
those
that
mlr
calculation
is
always
done
in
a
prospective
manner,
which
means
we
won't
be
looking
at
the
90
until
after
the
end
of
the
period.
So
so
we'll
be
looking
at
that,
I
believe,
first
of
the
year
of
2022
for
the
the
20
for
that
period
that
in
which
these
payments
were
made
to
make
sure
that
the
90
90
cents
on
the
dollar
was
paid
for
benefits.
E
But
the
other
thing
that
that
it's
doing
that
caused
this
a
large
piece
of
this
is
the
program
change
the
programmatic
changes
that
have
been
done.
I
know
that
there
was
a
one
bill
that
we
we
had
to
increase
the
cap
payment,
because
we
we
the
cares.
What
was
it
the
for
dme
services,
where
we
had
to
follow
the
that
house
bill
and
we
set
a
floor
payment
on
dme
services?
E
We
also
had
other
things
that
we
did
as
a
result
of
the
pandemic,
such
as
drg,
we
adjusted
the
drg
when
we
adjusted
drg
so
does
the
so
does
the
mco,
so
some
of
that
was
tied
to
the
to
to
that
increase.
The
other
increase.
Now,
when
I'm
saying
683
million
on
that
that
next
dot
that
next
point
for
house
bill
183
that
was
passed
in
the
2021
session
for
the
hrip
program
that
was
683
in
increase
over
what
we
spent
in
20.
E
all
right.
So
we've
spent
we
paid
almost
700
and
something
it
was
in
the
seven
or
almost
eight
hundred
million
dollars
in
a
trip
pro
payments
in
state
fiscal
year
21..
However,
it's
always
a
lag
there's.
Always
a
quarter
lag,
so
we
we
just
paid
to
another
287
million
to
the
hospitals
in
this
program
which
put
us
over
the
billion
dollar
mark
for
if
you
look
at
it
as
a
service
date
versus
the
paid
date.
E
So
I
just
wanted
to
point
that
out
that
683
is
just
the
increase
amount
from
21
what
we
paid
over
20.
and
the
reason
for
that
is
you
know
we.
We
started
house
bill
320
in
the.
I
think
it
was
the
2020
session
or
maybe
2019
session,
where
we
paid
this
a
trip
program
using
an
upper
payment
limit
methodology,
but
then
house
bill
183
that
was
passed
in
the
2021
session,
increased
that
up
to
the
average
commercial
rates.
So
that's
why
we
had
that
increase
there,
the
university
directed
payment.
E
E
The
other
thing
is:
there's
been
some
hospitals
that
the
universities
have
gone
into.
Agreements
with,
such
as
university
of
louisville
has
gone
into
agreements
with
jewish
norton's
and
university
of
kentucky
hospital
has
gone
into
an
agreement
with
king's
daughters,
and
so
when
they
do
that
it
brings
those
those
hospitals
into
that
program.
E
So
that's
another
reason
why
that
increased
the
universities
paid
the
state
portion
of
those
payments,
as
well
as
the
hospitals
pay
an
assessment
to
cover
the
state
portion
of
their
payments,
and
what
I'm
giving
you
here
is
total
dollars
not
is
total
fines
and
then
the
last
thing
I'll
mention
is.
We
had
a
26
million
dollar
increase
due
to
house
bill,
eight,
which
is
the
ambulance
per
trip
add-on
that
was
passed
in
2020.
E
I
know
there's
a
lot
of
information,
and
so,
if
you
have
any
more
questions
on
that
I'll
be
glad
to
answer
those
here
here
in
a
minute.
The
next
slide
is
a
per
member
per
month
slide
it.
It
shows
you
that
17.8
percent
increase
it
shows
you
by
our
medicaid
population
or
our
traditional
population
compared
to
our
expansion
and
chip
populations.
E
You
can
see
that
we
did
have
an
increase
in
21
over
20,
like
we
have
said
before,
but
the
majority
of
our
increase
was
in
the
expansion
line.
So
let
me
talk
about
that.
Real
quick
is
in
that
expansion
line
is
including
those
p
e
numbers
because
of
the
poverty
levels
of
which
there
they
we
that
they
are
in
we
had
to.
We
had
to
for
cms
purposes
on
the
cms64
report,
those
under
the
expansion
population.
So
that's
why
you
see
that
big
huge
jump.
E
E
They
don't
have
as
much
utilization
as
often
utilization
as
our
traditional
population
and
when
they
do
receive
those
those
those
services,
it's
not
as
as
expensive,
so
to
speak
as
what
what
our
traditional
population
receives
and
because
you
know
just
to
be
frankly,
honest.
Our
traditional
population
is
our
sickest
and
most
vulnerable
population.
So
yes,
they're
going
to
have
a
higher
higher
dollar
tax,
a
higher
price
tag
tied
to
their
expenditure.
E
Before
I
go
into
this
next
slide,
I
just
want
to
talk
about
present.
This
is
not
an
exhausted
list.
This
is
just
to
give
you
a
an
example
of
what
we've
been
doing
for
our
help:
our
providers
during
the
public
health
emergency
and
before
I
go
into
that,
I
just
want
us.
If
I
may
just
take
a
brief
moment
and
just
say
something
about
our
staff
at
medicaid,
our
staff
and
medicaid
have
been
very
dedicated.
E
E
The
things
that
we
we
want
to
implement
these
programs
that
we
want
to
implement.
They
don't
happen
overnight.
It
takes
a
lot
of
effort.
I
talked
with
you
just
a
second
ago
about
house
bill
8
how
we
had
to
go
back
and
forth
with
cms
there's
a
lot
of
that
going
on
behind
the
scenes
that
a
lot
of
people-
just
I
don't
think
realize-
takes
place
in
the
medicaid
program.
E
E
I
don't
think
a
lot
of
people
understand
or
realize
is
that
by
doing
that,
it
also
helps
reduce
uncompensated
care
for
some
of
our
providers,
because
if
we
did
not
do
this,
those
services
would
have
still
been
sought
out
by
those
individuals,
but
it
could
have
been
uncompensated
to
our
providers,
so
so
that
does
it
did
help
reduce
some
of
the
uncompensated
care
during
during
this
time
prior
authorization
requirements.
We
eliminated
those
for
covert
19
related
services,
including
hospitalizations
and
office
visits.
E
The
drg,
the
diagnostic
related
group
reimbursement,
that's
what
we
pay
hospitals
we.
What
we
did
for
that
is
we
updated
the
drg
to
a
more
updated
version
of
the
grouper
which
indicate
which
included
diagnosis,
codes
for
coven,
19
and
then
implemented.
We
implemented
a
20
add-on
to
the
weight
of
any
drg
that
was
assigned
to
a
claim
that
had
a
covet
19
diagnosis
code.
E
Telehealth
telehealth
is
something
that
we
are
looking
at
wanting
to
continue
even
post
pandemic,
because
we
want
to
encourage-
and
we
did
this-
to
encourage
and
expand
the
we
encouraged
and
expanded
the
use
of
telehealth
services
through
our
our
providers.
But
it's
it's
been
amazing.
What
we've
seen
from
the
telehealth
services
that
that
are
being
delivered,
but
it
the
on
the
early.
E
What
we
were
trying
to
do
with
that
was
to
limit
the
exposure
to
people
on
the
in-person
trips
for
to
medical
facilities,
but
but
what
we
found
out
is
that
there
was
a
lot
of
people
did
not
just
not
go
into
their,
but
they
would
be
more
willing
to
do
a
telehealth
visit
so
so
we're
we're
exploring
those
even
post
pandemic
on
those
services.
The
the
next
slide
is
is
just
a
few
more
things
cost
report
process.
E
We
we
did
extend
the
due
dates
for
cost
reports
to
try
to
ease
the
administrative
burden
on
providers.
We
extended
that
six
months
that
was
consistent
with
what
medicare
did
on
what
cms
did
on
the
medicare
cost
report
side.
Recoupments.
We
allowed
providers
that
had
old
funds
back
to
the
to
the
program
that
we
may
be
in
recouping
on
through
accounts,
receivable
documentations
that
we
had,
we
allowed
them
to
request
stays
on
those
recruitments
if
they
were
having
cash
flow
issues.
E
We
worked
with
the
department
of
revenue
that
department
of
revenue
intercepts
medicaid
dollars
to
collect
some
of
their
their
outstanding
receivables
on
their
end
from
some
of
these
providers,
and
so
we
work
with
the
department
of
revenue
to
have
that
temporarily
discontinued
so
that
the
cash
flow
of
providers
could
still
you
know
it
would
not
hurt
the
cash
flow
of
the
provider,
especially
during
this
time
nursing
facilities.
We
implemented
several
things
for
nursing
facilities.
We
did
a
270
dollar
add-on
for
coveted
positive
patients.
E
We
we
extended
the
bed
holds,
and
what
that
is
is
is
if,
if
I
may
put
it
in
my
my
words,
my
my
way
I
can
understand
it
is-
is
that
when
a
person
in
a
nursing
facility
gets
put
into
the
you
know,
she
has
he
or
she
goes
to
the
hospital
they.
We
pay
them
to
hold
that
bed
open
for
them
people,
so
we
pay
them
the
per
diem
amount
for
14
days.
We
extended
that
to
30
days,
and
I
believe
we
were
the.
E
E
We
we,
like,
I
said
earlier,
we
did
implement
the
29
add-on
and
that
was
put
in
house
bill
192
in
the
budget
bill
to
to
address
the
personal,
the
ppe
equipment,
the
cova
testing
and
the
staffing
issues,
and
one
thing
that
we
did
that
you
can't
put
a
kind
of
a
a
dollar
with
or
you.
We
did
streamline
the
residential
application
process
by
accepting
those
client
statements
as
their
verification
of
assets.
Instead
of
going
forward
through
the
entire
process
of
verifying
those
assets.
D
If
you
could
go
back
to
the
previous
slide,
I
just
wanted
to
point
out
and
just
thank
the
legislators
too,
for
the
29
add-on.
I
know
the
providers
were
very
thankful
for
that,
and
the
the
legislators
are
very
instrumental
in
passing
that
we
have
been
receiving
some
questions
from
providers
regarding
how
long
that
29
add-on
will
be
in
place,
and
it's
our
understanding
that
the
language
in
the
budget
bill
states
that
the
29
add-on
is
in
effect
until
december
31st
or
the
end
of
the
public
health
emergency.
D
E
E
E
We
get
several
different,
fmaps
federal
matching
percentages
and
it's
based
on
the
job
duties.
It's
based
on
the
duty,
if
it's
a
ddi,
which
means
a
design
developer,
implement
of
a
it
system,
we
do
get
90
10
on
the
front,
end
90
federal
dollars,
10
state,
and
then
then
it
goes
down
to
50,
fit
all
the
way
down
to
50
50..
Sometimes
we
get
75
25
based
on
it.
You
know
based
on
the
the
situation,
but
most
times
we
go
down
to
50
50
on
the
admin.
D
E
Correct
that
is
correct
again,
based
on
just
to
kind
of
mirror
what
we
did
for
the
benefits.
I'll
just
show
you
that
we
were
93.5
is
what
we
spent
of
our
budgeted
appropriations
and
expenditures.
I
can
tell
you
that
we
did
not
push
any
payments
in
admin
or
benefits.
What
that
means
is
that
if
we
had
an
invoice
for
it
in
admin,
it
was
paid
in
2021.
There
was
nothing
that
wrote
over
to
the
next
year
on
benefits.
We
we
do
not
have
what
they
call
a
prudent
pay.
E
We
do
not
have
that
implemented
any
more
any
longer.
We
pay
that
when
you
get
when
we
get
the
claim
when
we
run
that
claim
process
when
we
run
our
financial
cycle,
if
we
have
a
paid
claim
in
the
system
you
got
paid,
we
didn't
have
to.
We
didn't
hold
that
claim
for
17
19
days
before
we
released
it
for
payment.
We
did
not
push
any
any
managed
care
payments.
E
We
did
not
push
any
emt
payments,
so
we've
worked
hard
to
get
all
those
caught
up,
and
so
we
we
did
not
push
anything
so
in
this
admin.
When
I'm
looking
at
this,
yes,
we
had
15
million
dollars,
left
over
federal
dollars
and
1.9
and
the
the
reason
why
we
may
have
had
that
is
the
timing
of
which
some
of
these
I.t
procurements
and-
and
things
are
going
on-
that-
maybe
did
not
happen
in
the
in
the
time
frames
in
which
we
thought
was
gonna
happen.
E
The
last
slide
is,
let
me
reword
it
a
little
bit.
I
know
in
the
past
senator
alvarado,
you
not
like
this.
This
slide
much
because
you
say
it
doesn't
depict
the
managed
care
admin.
So,
let's,
let
me
just
say
it
this
way
is
we
had
two
appropriation
units
in
medicaid
budget?
We
have
the
benefits
appropriation
unit
and
the
admin
appropriation
unit
and
what
we
spent
is
of
our
total
budget.
D
A
Appreciate
the
presentation-
and
let
me
preface
any
questions
you
might
have
to
just
express
my
appreciation
to
you,
commissioner,
leander
steve.
I
think
you
do
a
great
job
for
our
program.
I
know
you
have
a
real
commitment
to
it
in
taking
you
steve
this
fiduciary
responsibility
here
with
this
is
certainly
second
to
none,
and
I
do
remember
the
bechtel
pyramid
triangle
triangle.
I
efficiently
refer
to
it
as
the
bechtel
bermuda
triangle,
but
that's
out
of
affection
for
you.
You
do
a
great
job,
a
lot
of
information.
We
will
have
several
questions.
B
B
E
E
Now
I
will
tell
you
this:
they
cannot
get
a
trip
any
longer,
so
they
were
getting
a
trip
at
one
time,
both
king's
daughters
and
jewish
and
all
that.
But
when
they
come
into
the
university
program
they
can't
double
dip.
They
can
only
get
it
for
one
or
the
or
the
other
program,
so
they
moved
into
that
university
program,
which
is
why
the
university
side
went
up,
but
probably
it
probably
had
a
teeter-totter
effect
on
the
a
trip
program.
D
So
so
steve,
if
I'm
gonna,
I
wanna
try
to
paraphrase
a
little
bit.
So
you
can.
You
can
correct
me.
So
what
happens
with
our
university
partnerships
or
university?
The
gme
program
universities
can
can
pay
us.
We
look
at
the
services
provided
by
their
providers
and
then
we
pull
them
in
and
we
do
some
calculations
and
so
for
services
provided
through
those
universities
they
receive
payments.
D
We
can
receive
additional
payments
from
the
from
the
federal
government
from
cms,
but
the
universities
put
up
that
state
match
and
those
payments
get
them
up
to
an
upper
payment
limits.
For
example,
they
receive
a
little
bit
more
money.
A
trip
is
different
in
that
the
universities
can't
participate
in
it
because
they're
already
drawing
down
those
federal
dollars,
enhanced
dollars
for
the
services
that
are
being
provided
through
their
facilities.
So
a
trip
is
for
those
providers
who
are
not
in
a
and
not
participating
with
that
university
gme
program.
E
So,
representative
bentley,
I
don't
want
to
confuse
you
any
further,
but
I'll
just
say
also
that
the
university
side
they
pay,
what
we
call
an
igt
which
is
intergovernmental
transfer,
which
they
paid
the
state
portion
right
back
to
us.
Whatever
the
state
match
was
that's
what
they
pay
us.
That's
what
the
universities
pay
on
the
a
trip
side.
It's
an
assessment.
E
We
we
are
mandated
by
federal
register
to
not
exceed
six
percent
of
their
gross
revenues,
so
we
had
to
do
a
beta
test
and
everything
on
the
a
trip
side
to
determine
a
per
discharge
amount
to
assign
to
that
to
cover
to
help
cover
that
that
that
the
state
match
the
state
portion
of
those
payments.
I
hope
that
doesn't
confuse
you
any
further.
If
so
I'll
be
glad
to
sit
down
with
you
and
show
you
a
little
more.
B
Thank
you
very
much
one
more
question.
Well,
certainly,
please
jeremy.
This
is
more
like
micromanagement
here.
I
listened
to
my
people
in
my
area
and
they
said
that
the
obot
programs
that
don't
prescribe
methadone
need
a
bundle
code
similar
to
an
ntp
or
otp.
It's
the
only
way
they'll
get
paid.
Is
that
true.
E
D
I
think
you're
you're
talking
about
the
outpatient,
the
substance
use
treatment.
We
do
have
different
rates,
we
have
different
rates
and
different
different
reimbursement
methodologies,
depending
on
the
specific
provider
type.
We
I
think
what
you're
talking
about
is
the
methadone.
Are
you
talking
about
the
methadone
clinics.
D
We
do
have
a
different
different
reimbursement
methodology
for
those
again
we'd
be
more
than
happy
to
sit
down
and
go
through
some
of
that
rape
methodology
with
you.
I
think
there
is
a
an
upcoming
meeting
that
specifically
devoted
to
substance,
use
disorder
and
some
of
the
coverage
options
there.
So
again,
we'd
be
more
than
happy
to
put
together
a
a
presentation
outlining
how
we
reimburse
for
our
behavioral
health
services,
including
the
outpatient
treatment
facilities.
B
A
C
So
I
would
think
that
had
a
lot
to
do
with
it,
but
you
guys
can
correct
me
with
that.
I
I
think
that
was
about
probably
30
40
million
more
than
what
we
would
have
expected.
Otherwise,
and
but
anyway,
I
just
want
to
say
I'm
anxious
to
see
additional
costs
come
into
that.
There's
a
lot
more
to
play
with
that.
I
know
but
but
that
was
a
good
sign.
Just
seeing
that-
and
I
don't
think
that's
a
you
know,
that's
any
kind
of
accident.
C
When
you
all
decided
to
hire
a
single
pbm,
was
there
some
reason
that
you
decided
to
stay
with
a
capitation
rate
rather
than
go
with
a
percentage,
since
you
were
going
fee-for-service
using
a
percentage,
because
I
feel
like
going
with
a
capitation
rate
when
you
did
that
it
left
money
on
the
table
for
the
taxpayers
to
pay,
and
that
that's-
and
I
think
you
might
understand
what
I'm
saying.
Is
there
any
some
reason
why
we
we?
We
stayed
with
that
fee
for
the
capitation
rate,
when
it
came
to
the
single
pbm.
D
I
believe
that
one
of
the
major
reasons
is
ease
of
implementation,
and
this
was
the
first
time
that
we
had
ever
done
anything
like
this
in
the
country
so
again
brand
new.
We
we
stuck
with
that
because
again,
ease
of
implementation
and
senate
bill
50
was
implemented
on
july,
1st
2021.
So
I
think
that
we
we
definitely
need
to
to
keep
an
eye
on
it
and
do
some
monitoring
do
some
reporting
to
see
how
the
the
true
impact
on
the
member,
the
provider
and
the
budget
and
again
appreciate
your
all's
collaboration
on
that.
D
We
we've
heard
some
really
good
things,
not
only
in
in
our
within
the
commonwealth,
but
externally
we
have
several
states
that
are
looking
at
what
we
have
done.
They
really
like
the
idea
of
having
that
single
benefit,
a
single
pharmacy
benefit,
but
holding
the
mcos
accountable
for
the
administration
costs,
but
again
going
back
to
the
capitation
again
ease
of
implementation
and-
and
all
of
this
was
just
brand
new.
C
Well,
that
is
a
very
honest
answer
and
that's
the
problem.
I'm
sure
it's
the
way
I
would
have
gone
as
well,
given
the
time
frame
that
you
had,
but
I
really
do
believe
just
to
look
forward
to
the
future.
I
think
we've
got
millions
that
are
still
out
there
that
we
can
look
at
in
the
coming
years
as
we
stick
with
this
structure.
D
And
I
I
think
that
senate
bill
52
was
just
the
very
first
step
in
reforming
our
pharmacy
benefit
program.
I
think
we
definitely
need
to
keep
an
eye
on
it
and
continue
to
to
look
at
the
impact
again
because
of
ease
of
implementation.
We
had
originally
looked
at
tiering,
some
of
our
dispensing
fees.
You
know
we
didn't
didn't,
go
down
that
route
again
because
of
ease
of
implementation,
but
I
think
that
working
together
and
and
getting
information
into
your
hands
and
the
reports
on
the
impact.
C
E
C
That's
great
and
thank
you
so
much
for
your
presentation
again
and
one
last
thing
you
guys
get
ready.
It
won't
have
anything
to
do
with
medicaid,
but
for
what
we've
saved
the
taxpayer
and
how
we've
been
able
to
do
it
in
the
state.
We
want
to
do
that
also
in
the
other
sector,
the
other
half
of
the
prescriptions
in
the
state.
So
you
all
get
ready
for
that.
Thank
you
very
much.
B
Yes,
thank
you
chairman.
I
just
wanted
to
echo
the
comments
that
representative
sheldon
made
and
certainly
acknowledge
and
thank
them
for
for
all
the
efforts
and
all
the
programs
they've
put
forth,
but
I
also
just
wanted
to
take
the
time
to
remind
everyone
that
you
know
we.
I
would
like
to
see
us
focus
more
on
funding
of
community-based
services
as
well,
particularly
adult
day.
B
A
A
Now
we
won't
let
you
retire.
I'm
sorry.
We
would
like
to
see,
I
think,
expanded
the
pond
and
the
only
reason
I
think
that
we
don't
like
this
slide
is
truly
truly
doesn't
recognize
the
total
administrative
expense
for
the
medicaid
program
recognizing
the
mcos
portion.
So
surely
somebody
has
identified
for
us.
What
is
our
total
administrative
expense
for
the
medicaid
program.
E
Yeah
we
we
can,
we
can
dig
into
that
the
actual
expenditures-
I
I
you
know
I
would
have
to
look
at
some
of
the
provider,
some
of
the
managed
carers
naic
reports
or
get
some
data
from
them,
but
I
will
say
that
we
we
always
allow
about
a
10
percent
margin
at
90.
90
mlr
gives
them
a
10
margin
to
to
cover
admin
and
profit
margin.
E
A
Appreciate,
if
you
do
that
and
don't
mean
to
create
work
for
you,
but
I
suspicion
that
it
may
be
a
little
bit
more
than
10
and
once
you
look
at
everything,
but
I
have
no
way
of
validating
that
other
than
to
know
that
we
never
have
a
lack
of
interest
from
the
mcos
and
want
to
participate
in
this
program.
So
the
profit
margin's
going
to
be
quite
substantial
and
I
think
that's
something
that
we
need
to
look
at.
You
know.
E
D
So
what
I'm
hearing
that
the
committee
would
like
to
see
is
another
slide
very,
almost
identical
to
the
fee
for
service
broken
out
only
by
mco
and
what
they're
actually
spending
on
it
on
benefits
their
admin
and
any
other
expenditures
that
are
in
there,
such
as
any
quality
initiatives
that
they're
doing
or
value
add
benefits.
So
that's
what
I'm
hearing
is
another
slide
representing
mco.
A
E
I
do
not
compare
that
to
other
states
no,
but
I
I
can
reach
out.
I
participate
in
a
with
the
national
association
for
medical
directors.
I
do
participate
in
a
cfo
affinity
group
where
I
talk
with
other
cfos
around
the
nation,
so
I
can
reach
out
to
a
few
of
my
counterparts
and
and
try
to
get
something
for
you.
A
You
have
you
referenced
very
early
on
that
you
know
we're
apparently
the
third
poorest
state,
and
that
certainly
does
reflect
in
our
medicaid
enrollment
and
that
itself
is
tragic.
I've
said
before
and
I'll
say
it
my
dying
day
that
I
think
the
litmus
test
for
any
governor
of
the
state
should
be
the
number
of
people
we
have
on
medicaid
program,
and
I
made
that
same
comment
when
the
previous
governor
was
office.
A
So
it's
not
political,
it's
just
from
a
a
taxpayer
perspective
and
I
think
we
can
do
a
much
better
job
than
we
have
been.
You
know
that
senator
alvarado
and
I
both
have
been
promoting
to
do
a
different
program
rather
than
mco
and
aso,
and
when
you
see
states
like
connecticut
who
had
their
aso
since
I
think
2014
I
believe
is
when
they
implemented
it
and
their
administrative
expense
ratio
is
right
at
three
percent.
You
apply
those
same
numbers
to
our
program.
A
E
That
is
correct.
We,
when
we
do
our
budget,
we
look
at
today
and
we
we
trend
forward.
We
do
some
trend,
analysis
and
some
forecasts
and
we
go
through
a
consensus,
forecast
group
with
the
the
budget
director's
office
budget
hicks's
office,
and
so
we
we,
you
know
it
is
just
looking
at
today.
So
any
any
legislation
or
anything
that
you
all
do
this
coming
upcoming
legislation,
we,
it
will
not
be
included
in
my
budget.
E
A
You
know
we
were
47th,
I
think,
a
decade
ago
we
have
moved
up
to
44
and
I
don't
think
that's,
because
that
our
mcos
have
done
a
good
job.
I
think
it's
because
we
have
more
access
to
the
health
care
coverage
under
the
accountable
of
the
accountable
care
act
and
the
the
biggest
potential
savings
is
improving.
The
health
population
and
we've
got
to
focus
upon
that
and
I
don't
think
we've
done
a
very
good
job
there.
A
We'll
have
a
chance
to
discuss
this
more
detail.
The
next
medicaid
oversight
committee
meeting
next
friday,
but
great
presentation
always
appreciate
the
dialogue
with
you
folks,
you're,
always
open
candid
with
us,
and
I
appreciate
your
testimony
today
and
look
forward
to
continuing
to
work
together.
Thank
you.
Thank
you.
A
I'm
going
to
move
on
to
our
second
item
and
last
item,
which
is
reimbursing
for
adult
day
care.
Health
centers,
and
we
have
mr
kelly
upchurch-
is
here
and
he's
brought
a
guest
with
him,
and
I
think
they
both
know
the
routine.
If
you
would
identify
yourself
for
the
record
and
though
you
feel
free
to
proceed.
F
A
A
B
D
D
F
Okay
well,
first
of
all,
let
me
thank
the
subcommittee
on
human
resources
for
allowing
me
to
speak
and
for
melinda
to
speak,
and
we
we
certainly
appreciate
the
opportunity.
I
realized
that
there's
not
going
to
be
as
many
zeros
in
my
presentation
as
there
was
in
the
first
one,
but
please
don't
think
that
that
diminishes
the
the
need
and
the
importance
of
what
we're
going
to
say.
But
again,
thank
you
so
much
for
allowing
me
to
testify.
F
F
We
provide
services
using
our
services
as
well
as
natural
support,
so
folks
that
are
in
the
home
in
the
family
members,
caregivers,
we
we
we
assist
them
with
and
and
lift
them
up
with
services.
We
provide
again
with
the
intent
on
keeping
those
folks
out
of
institutional
care,
home
and
community
based
waiver
services.
Are
the
most
cost
effective
for
that
service.
F
There
are
five
models
which
I'm
sure
you
all
have
heard,
or
will
hear
testimony
for
abi
model,
2
waiver,
michelle
p
and
scl
the
ones
we're
going
to
talk
about
today
in
my
presentation
is
a
home
community
based
home
and
community
based
is
part
of
the
1915
waiver.
It
provides
assistance
to
elderly
and
to
adults
with
physical
disabilities
to
help
them
live
in
the
community
independently,
all
our
patients
that
are
enrolled.
As
I
said
on
monday,
all
these
patients
that
are
enrolled
in
this
program
could
choose
long-term
care.
F
All
we
have
9
700,
plus
patients
enrolled
all
of
them.
If
they,
if
they
wanted,
could
choose
long-term
care
if
they
could
find
a
bed.
It's
important
to
note
that
our
efforts
are
to
keep
those
folks
in
the
home
as
long
as
we
possibly
can
adult
day,
services
as
a
whole,
there
are
118
adult
day,
centers
throughout
the
commonwealth,
I'll
make
a
asterisk
beside
that
comment
in
that
because
of
covid.
F
We
don't
know
that
that
number
is
118
and
I'll
explain
that
in
just
a
little
bit
that
could
be
much
less
than
that
adult
day.
Is
the
safety
net
for
frail
elderly
and
disabled
folks,
and
what
I
mean
by
that
is
there's
nothing
in
between
us
in
long-term
care.
Adult
day
is
the
program
that
is
designed
to
serve
those
folks
that
need-
and
you
have
all
seen
this
in
in
with
your
loved
ones
or
with
folks.
F
What
are
you
going
to
do
with
that
with
your
mother,
your
father,
your
aunt,
your
uncle,
your
husband
or
your
wife,
when
that,
when
those
folks
just
can't
hardly
make
it
than
the
day
without
some
assistance,
you
might
have
a
job.
You
might
have
other
health
issues
that
you
can't
that
you
can't
physically
take
care
of
them.
F
It's
an
all-inclusive
model,
there's
no
a
la
carte
type
of
services.
When
we
admit
a
patient,
we
take
care
of
that
patient.
We
don't
trim
off
other
services
that
they
might
need
in
the
adult
day
setting,
for
instance,
if
they,
if
they
need
an
injection,
we
don't
charge
them
extra
for
that.
If
they
need
a
bath,
we
don't
charge
them
extra.
For
that
they
need
wound
care.
We
don't
charge
them
extra
for
that.
F
It's
one
fee
for
service
our
fee
right
now
and
and
don't
want
to
stun
you
for
adult
day
within
the
boxes
of
the
adult
day,
is
11.32
cents
an
hour,
11
and
32
cents
an
hour
folks.
I
don't
know
if
that
number
stunned.
You
like
it
does
me
when
I
say
it
out
loud,
but
you
can't
get
someone
to
flip
your
hamburger
for
11.32
cents
an
hour.
We
can
do
that
in
adult
day
setting
because
it's
a
congregate
setting.
We
bring
those
folks
to
our
adult
day
center.
F
Some
of
the
things
that
are
in
our
our
facility,
some
of
the
things
you're
going
to
see
going
on,
of
course,
is
skilled,
nursing
care,
medication
management,
chronic
disease
care
wound
care.
I
intentionally
skipped
in
homotenor
karen
we'll
talk
about
that
in
a
minute,
all
trait
care,
urinary,
catheter
care.
We
provide
ptlt
and
speech,
nutritious
meals,
case
management,
services,
day
supervision,
socialization
respite
and
transportation
services.
F
and
I
know
central
meredith,
as
you
alluded
to
earlier.
It's
true
everybody
is
here
saying
we
haven't
had
a
raise
in
a
long
time
and
I'm
that
doesn't
escape
me.
Our
our
our
functioning
goal
is
to
take
care
of
people.
I
want
to
we're
asking
of
course-
and
everyone
here
is
asking-
is
just
the
ability
to
do
that
without
without
just
eliminating
a
service
line
altogether.
F
F
F
Adult
day,
healthcare's
response
to
covet
19.,
I
want
to
throw
this
in
there
just
because
everybody
has
a
an
idea
about
what
is
going
on
and
what
services
are.
As
some
of
you
know,
in
march
of
2020,
adult
days
through
the
mandate
were
shut
down.
We
almost
immediately
had
to
figure
out
how
we're
going
to
take
care
of
our
folks
how
if
they
can't
come
to
the
adult
day
center,
what
are
we
going
to
do?
F
And
I'm
very
proud
of
the
reaction
and
response
that
adult
day,
health
care
provided
during
this
crisis
and
continue
to
provide
during
this
crisis
we
almost
overnight
from
a
friday
to
a
monday,
shifted
all
services
from
all
for
nine
thousand
patients
from
the
adult
day
setting
to
a
in-home
attendance
care
setting,
we
made
sure
that
those
patients
that
fell
through
that
would
possibly
fall
through
the
cracks.
Those
patients
that
are
receiving
skilled
care
continue
to
get
that
skilled
care
in
their
home.
F
Now,
here's
the
trick.
It's
not
a
magic
trick.
It's
a
it's
a
it's
a
it's!
It's
a
little
painful
that
they
even
say,
but
we
would
send
our
staff
and
continue
to
do
that
in
some
cases
into
that
person's
home
for
11.32
cents
an
hour
and
and
if
you're
in
the
healthcare
industry-
or
you
know,
someone
who
is
most
most
rns
are
reimbursed
at
around
30
an
hour.
F
F
In
some
scenarios
we
provided,
as
I
said
earlier,
in
homes,
skilled
nursing
care
for
11
and
32
cents
an
hour,
and
some
are
still
doing
that,
one
of
the
things
that
we
stepped
up
and
did
and-
and
I
want
to
applaud
the
cabinet
for
allowing
that
and
being
forward
thinking
and
doing
this,
but
one
of
the
things
that
we
we
have
done
just
adult
day
facilities.
This
is
just
our
target.
Of
course,
that
number
is
somewhere
around
5
million
but
adult
day
provided
776
000
meals
to
participants
in
their
home.
F
The
reason
why
that's
important
is
meals
are
part
of
the
the
service
in
an
adult
day
setting
a
lot
of
the
adult
day.
Patients
come
to
the
adult
day
and
part
of
the
attraction
of
that
is.
There
is
a
meal
that
we
provide,
so
not
coming
to
the
adult
day
would
mean
for
a
lot
of
our
patients
no
meal
for
that
day.
F
F
Some
of
the
impacts
that
we've
seen
of
covid
statewide-
and
please
know
this
is
not
a
scientific
study.
This
is
just
me
on
the
telephone
calling
up
our
adult
day,
colleagues
and
asking
them
a
series
of
questions.
Some
I
could
not
reach
on
the
phone
and
I
got
bounce
backs
from
their
emails.
That's
why
I
say
I
don't
know
if
there's
118
still
here
but
of
the
ones
that
I
could
reach
and-
and
I
don't
want
to
paint
a
bleak
picture,
and
I
hope
that
I
can.
F
I
can
paint
a
a
better
picture
at
the
end
of
this
discussion
when
I
answer
questions,
but
right
now
we
know
without
a
question
they're
permanently
or
will
close
permanently
for
adult
day
centers.
There
are
eight
centers
that
that
had
questions
of
whether
they
were
they
were
temporarily
closed.
Now,
whether
they're
going
to
be
able
to
reopen
they're,
they
remain
shuttered
and
whether
they're
going
to
reopen
they're
just
uncertain
of
whether
they're
going
to
do
that
percent
of
the
people
that
I
called
on.
F
F
The
primary
reason
for
this
folks
and
it
comes
back
to
providing
services
in
a
congregate
setting
the
adult
days,
reported
the
distancing
requirements
and
the
patient's
inability
to
mask
as
the
primary
difficulty
with
those
folks
coming
back
into
attendance
and
that
shouldn't
shock
anybody.
That's
not
a
surprise
and
we're
not.
Please
don't
take
this
wrong.
We're
not
opposed
to
any
of
those
restrictions.
I
think
it's
keeping
our
folks
safe,
there's
not
been
a
single
by
the
way.
F
A
hundred
percent
of
the
respondents
reported
difficulties
in
hiring
and
retaining
staff.
Folks,
we
are
in
a
crisis
right
now,
and
I
know
I
don't
have
to
share
that
with
this
committee,
because
you're
painfully
aware
of
that,
we
have
to
be
able
to
pay
a
decent
wage
to
have
someone
work
for
us.
That's
just
the
bottom
line.
We
just
have
to
be
able
to
do
it,
recommendations
very,
very
direct
recommendations.
F
F
We're
also
asking
the
one-time,
arpa
funds
be
granted
to
assist
adult
days
in
recovering
from
the
coven
19
related
losses.
Certainly,
restrictions
from
of
six
feet.
Restrictions
and
masking
has
has
done
its
damage
for
a
lot
of
providers,
but
certainly
has
impacted
us
as
well
we're
asking
for
a
adult
day
rate
increase
both
adult
day
and
attendant
care
of
a
10
percent.
As
I
said
earlier,
the
last
rate
increase
that
we
we
obtained
was
in
2016.
F
folks
that
10
rate
increase,
although
that
number
seems
big,
that
really
doesn't
even
keep
up
with
the
inflation
rate
of
2.23
percent
since
2016
to
date.
So
we're
really
not
even
asking
to
be
kept
up
to
the
inflation
rate
here
we,
the
final
thing
that
we
would
like
to
ask
this
committee
humbly
asked
this
committee
is
that
the
legislature
consider
implementing
some
type
of
continued
funding
strategy
every
five
years
or
every
seven
years.
I
know
some
of
you
are
tired
of
seeing
me
if
you've
been
around
that
long.
F
A
And
do
appreciate
that
great
presentation.
You
know
I
did
hear
it
earlier
in
the
week,
but
it's
certainly
an
important
service
to
us,
and
I
think
one
of
the
struggles
is
that
we
don't
recognize
a
continuum
of
care
that
each
service
is
almost
like
a
kingdom
in
itself
and
we
kind
of
look
at
each
other
as
competitors.
A
A
B
F
F
F
A
F
Adult
day,
because
adult
day
provides
a
skilled
health
care
service,
all
those
services
that
we
provide,
I
would
certainly
wish
they
would
be
picked
up
by
a
lot
of
other
providers.
Certainly,
long-term
care
insurances
have
been
paying
for
adult
day
services
for
probably
20
years,
but
there
are
some
other
insurances
that
pay
for
adult
day
services.
A
A
Here,
representative
bentley,
you
have
the
last
award
in
this
meeting
all
right.
Thank
you
great
presentation
again,
and
we
certainly
understand
the
importance
of
adult
daycare
within
this
healthcare
continuum,
and
we
want
to
try
to
help
all
of
our
providers,
not
sure
what
that
looks
like
from
practical
standpoint,
but
again
focusing
on
spending
the
dollars
wisely.
Improving
the
health
of
kentuckians
is
where
we
had
a
great
opportunity,
but
your
message
has
not
fallen
on
deaf
ear
and
look
for
the
next
budget
cycle
to
see
what
we
could
possibly
do.